Advanced Rescue Training & Attendance Record

TRAINING RECORD
Liability Release and Medical Declaration Form

This is an activity registration form, training record and waiver.
RESCUE | EMERGENCIES | DISASTERS | MEDICAL | SAFETY

THIS IS AN OFFICIAL COURSE REGISTRATION & WAIVER.

This waiver must be fully completed by all participants. It also forms the basis of proof of your training.

Any issues or matters we should know about please put in the comments below.

LIABILITY RELEASE
I have been advised to bring suitable PPE and realise that it is my responsibility to where it (such as clear eye glasses) etc. I hereby acknowledge that I am fully aware of the risks to which I may be exposed during the Training Course, with potential minor and major accidents that may cause me or other person’s bodily harm and/or illness. I fully understand and accept that Advanced Rescue by DIMERSAR, The Emergency Response Team – Search and Rescue (ERT SAR), as well as connected agencies; the course coordinator, instructors and assistant personnel, have taken every precaution possible to prevent accidents, injuries and illness during the course. I agree to comply strictly with each and every safety standard of the Training Course. I furthermore pledge to ensure my own safety and the safety of all other course participants to the best of my ability. I will not recklessly endanger myself or other participants and in the event of any accident that may cause me bodily injury or illness during or after the Training Course, I hereby release The Police Charter, Advanced Rescue by DIMERSAR, The Emergency Response Team – Search & Rescue as well as course coordinator, instructors, assistant personnel, from all legal liability thereof.

WATER COURSES:

If this is a water / Ice related course I give my assurances to a good basic swimming ability (attest I can swim 100 yards in any stroke without a PFD and tread water for 10 minutes) and have a good basic fitness.

MEDICAL CONDITIONS & DECLARATION
I am fit enough to perform the fitness tests, active tasks pertaining to the expected requirements of the course including the carriage and use of equipment and WILL NOT hold ADVANCED RESCUE by DIMERSAR et al responsible. I am aware this is performed in varied terrain, often in extra heat or cold environments, remote areas and may be very tiring and strenuous. I will not perform solitary tasks that would be better with aid or assistance. I understand and am aware of the Medical issues and agree that it will not be a problem for me to participate in these activities. I will advise if I feel unfit or unwell and not leave without informing a person in authority that I intend to do so. I also acknowledge I have informed the instructor and my employer of any fitness or medical / mobility issues I have and written it on the back of this form. Please state below if appropriate.

MEDIA USE & RELEASE

From from time to time, the sessions are filmed, recorded, photographed and I acknowledge and agree to said filming, taping etc. and allow my image / recording to be included freely as needed including on websites, documents, manuals, news releases, etc.

AGREEMENT TO RECEIVE ELECTRONIC & OTHER COMMUNICATION
From time to time we may send you training and re-certification updates, new information, marketing, sales, notices, product recalls, legal notices, professional standards and other Instructor, Directing Staff or participant / attendee information. We require your agreement to do so as part of your training and certification. (If you decline to receive this you can do so later as an "Unsubscribe" button but we do emphasise this is necessary in many cases as part of your certification and we do NOT sell your lists on nor abuse this ability.

Signee Information

First Name *

Last Name *

Your Date of Birth *

Phone *

Email Address *

Confirm Email Address *

Address*

Address Line 2

City*

State/Province*

Postal Code*

Subject*

Please check the Rescue or Medical Subject activity or "Other" if none listed

Your Department *

Please put your Employer, Course Sponsor or Department to attend this course.

Any Health or Medical Conditions*

Please list any injuries you are managing, or other Issues, Medical or Health Conditions? (If NONE, state "None.")

Maiden Name (Security Question)*

Please state your Mother's Maiden Name

SWIMMER*

If this is a water course, please check here that you are a good swimmer in accordance with the standards as laid out. Thank you.

PRIVACY AND CONTACT*

Upon registering as a student or participant we will need to record and retain certain records as appropriate. We expect that you will agree to this however you may withdraw this permission at any time.

Please enter participants' full names:

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Attachments

Your Passport style headshot Photo *

We need a headshot for your form and possible training and ID cards. (Passport style photos are best. No one else in the photo. Photos taken now on your phone can be used. Clean background please.)

Proof of ID *

We need to verify the identification of those attending. A drivers license or passport is acceptable.

Sign Here

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.